The purpose of our review was to look at the quality of general practice complaint handling, to identify good practice and ways that the quality could be improved. We have identified five areas where we believe GP practices are falling short of what is required by both the Complaint Regulations (2009) and what we consider to be good complaint handling as set out in My expectations. As we want to support practices to improve, for each theme identified in the next section, we have included good and poor practice examples as well as identified key learning points where appropriate.

1. Listening culture: ask for feedback

A service that is safe, responsive and well-led will treat feedback, concerns and complaints as an opportunity to improve. We found that often opportunities are missed to respond to issues before they become complaints, as practices do not do enough to welcome feedback. Care Quality Commission inspectors and local Healthwatch found that practices commonly didn’t have information clearly displayed in the waiting area or on their website about how to feed back or complain. Furthermore, evidence from Care Quality Commission inspections showed that not all staff in the practice knew how complaints policies, if they existed at all, should be implemented.

Showing how feedback, concerns and complaints have been used to improve services, gives people confidence that raising issues can make a difference. However, there is some way to go; only a quarter of individuals who experience a problem with their practice make a complaint and only four in ten believe complaining to their GP will make a difference.19 More worryingly, half of those who do complain to their GP, are concerned it will affect their care and treatment, despite the NHS Constitution which states that ‘complaining … will not adversely affect your future treatment.’20 This highlights that unless practices invite feedback, they will miss opportunities to improve patient experience.

For practices to learn from feedback, concerns and complaints, they need to encourage feedback in all its forms and ensure people are told how to make a complaint as well as being signposted to sources of advice and support.'

Practices that are good at welcoming feedback, concerns and complaints do so through a variety of different methods. For example, suggestion boxes in the waiting area, acting on information in Friends and Family Test data21 and letting individuals know how their feedback has improved services through a ‘you said, we did’ notice board. In one practice we spoke to, the staff make a note of discussions they have had with individuals that they feel could have gone better. They then call the individual at the end of the day to ask for feedback on the discussion, removing the responsibility from the individual to raise a concern or complaint. One of the case examples included in this review highlights how a practice recently rated as outstanding by the Care Quality Commission pro-actively responds to individual feedback.

Another practice we spoke to told us ‘we have a culture where we escalate everything. We encourage verbal feedback and treat it like a written complaint… we’re a business, it’s just good customer service.’
Not all practices have the same welcoming attitude to concerns and complaints. Until they do, it will be impossible to ensure general practice has an open and learning ethos. For example, it was clear from our conversation with GPs that some consider complaints to be ‘gifts’, while others are fearful of encouraging concerns. Reasons ranged from fears about time taken up to deal with complaints, the potential financial impact of legal action or the Parliamentary and Health Service Ombudsman’s financial recommendations, and risking their practices’ reputation. Some GPs we spoke to felt their role should be limited to dealing with complaints only where clinical care and treatment were concerned. It is clear that there is some way to go before we can achieve a system wide culture change.

For practices to learn from feedback, concerns and complaints, they need to encourage feedback in all its forms and ensure people are told how to make a complaint as well as being signposted to sources of advice and support. The Parliamentary and Health Service Ombudsman research shows that GPs are the least likely NHS provider to offer advice or support to individuals making complaints when compared with dentists and hospital trusts.22 Similarly, basic information was not readily available and practices were not making people aware that they could take their complaint to the Parliamentary and Health Service Ombudsman.
Local Healthwatch have also highlighted inconsistencies in information about complaining across practices.23 Practices that don’t signpost to advocacy or provide basic information are falling short of their legal duties as set out in the NHS Complaint Regulations (2009).

Care Quality Commission case study

Complaints are no bad thing

During an inspection, the Care Quality Commission found that a practice with just two recorded complaints ‘required improvement’. The practice received a rating of inadequate for ‘are practices responsive to people’s needs?’- the main area where the quality of complaint handling is assessed. Inspectors found that:

there was no information available to help patients understand how to make a complaint;

some of the patients that the Care Quality Commission inspectors spoke to did not know how to complain and there was no defined system in place for handling complaints and concerns; and

the practice did not have a complaints policy or procedure setting out what to do. The practice manager resolved complaints as they arose but there were no records of investigations and responses.

As a result, there was no evidence of any sharing of what the practice had learned from individual complaints or how it had used complaints to improve the quality of care.

Care Quality Commission case study

Being responsive - an outstanding practice

A practice that received 32 complaints in 12 months was rated ‘outstanding’ by the Care Quality Commission. The practice was particularly good at creating a culture where feedback, concerns and complaints were welcomed and encouraged. It achieved this in the following ways:

Displaying a wide range of information to allow patients to access the complaints system including posters, leaflets, information on the practice’s website and information in the practice handbook.

Encouraging and engaging patients in the delivery of the service, including through patient feedback.

Creating a leaflet that detailed the complaints procedure and lists organisations that may be able to support individuals in making a complaint. The leaflet also contained a tear-off form for patients to complete if they wished to highlight any compliments, comments, concerns or complaints.

Displaying ‘We’re listening’ posters in the waiting area to show that feedback had been received along with the action that had been taken to respond.

Utilising the waiting area to encourage patients to feedback in person, via telephone or online.

The practice was able to show how it had responded to the 32 complaints in a thorough and timely manner, and demonstrated openness in responding to complaints. It learned from concerns and complaints and took action to improve the quality of care. The practice had a Lessons Learned newsletter that identified what it had learned from complaints, which it shared with all staff. Staff told the Care Quality Commission inspectors that the circulation of the newsletter helped to ensure that they were all aware of lessons learned.

Healthwatch England case study

Using evidence from local patients to improve access to online complaints resources

In April 2014, Healthwatch Dorset produced it’s Something to Complain About? report, which undertook a review of GP complaints services across 101 local GP practices. Healthwatch Dorset found that there were a series of inconsistencies in the provision of complaints information on local practice websites, saying that ‘many practices failed to provide good quality, detailed and up-to-date information’ for anyone considering making a complaint.24

Among its recommendations, Healthwatch Dorset called for all practices to regularly make sure that information is comprehensive, accurate and current. This information should be available on a single complaints page on a practice’s website.

A significant number of local practices responded positively to the report, with one member of staff calling the report ‘helpful and informative’. In a follow-up survey of local GP complaints services in March 2015, Healthwatch Dorset reported that 48 local practices had also updated their complaints information since the initial report was published. Many of those had updated the information on their websites, while half of the local practices without a website had since built one.

2. Regulations: make sure practice staff understand what is expected of them

It was clear from our review that most practices take complaints seriously, however, we were disappointed to find a lack of understanding from a number of practices about what they should be doing to manage complaints effectively. This includes processes, policies and due diligence. While almost all practices in England have declared that they do have a complaints policy, it is clear from Care Quality Commission inspections and our review, that where they do, they don’t always reflect the NHS Complaints Regulations and are not consistently used or understood by practice staff. GPs and practice managers felt that this was because the regulations were difficult to interpret and understand, particularly where some practices deal with few complaints.

Our review showed that sometimes practices fail to understand what the individual expects as a result of their feedback, perhaps owing to a lack of experience in dealing with feedback, concerns and complaints, making it very difficult to manage patient expectations, sometimes causing issues to worsen. Individuals may wish to resolve an issue informally by raising a concern or asking a question and others want to complain and expect a formal process to follow. Practice staff need to get better at understanding whether individuals want to provide feedback, raise concerns or complain, so that they can respond accordingly. Training to help practices with customer care and communication would be welcomed and may help prevent this issue. GPs told us ‘it would be helpful to have a complaint training exercise’.

Practice staff need to get better at understanding whether individuals want to provide feedback, raise concerns or complain so that they can respond accordingly.'

In both 2011 and 2012, the Parliamentary and Health Service Ombudsman raised concerns about unfair removal of patients from general practice lists. Despite agreement from GPs and practice managers that the guidance around removals is very clear, it was disappointing to find examples where this is still happening and practices are falling short of what is required.

While there were examples of practices that reluctantly used practice removal as a last resort, we found that some practices are removing patients from their lists without following due process, leaving individuals without access to care and putting them at risk. Examples of unfair removal included:

i) Not giving warnings - NHS contracts require general practices to give patients a warning before they are removed from their lists, unless there is violence or a police reported incident. This gives patients a chance to change their behaviour. The only exception includes a risk to health or safety or where it would be unreasonable or impractical to do so.

ii) Not allowing enough time to join another practice – patients should be given 28 days (unless in cases of violence or a police reported incident

iii) Removal as a result of making a complaint which does not indicate a breakdown of the doctor patient relationship.25

Parliamentary and Health Service Ombudsman case study

An unfair removal leaves an individual without access to medication

During a consultation Mr T told his GP that he had moved out of the area a while ago. They agreed that Mr T would join a new practice nearer to his home. Six days later Mr T logged onto the online system to order a repeat prescription but could not find his details. He called the Practice and a staff member explained that it had removed him from the patient list and that six days was enough time to have found another GP. Mr T felt six days was not enough time to make alternative arrangements. The Practice did not change its position, so Mr T complained in writing.

The first complaint response did not address Mr T’s main concern - whether the six days was reasonable, so he complained again. The Practice still felt that six days was long enough to find another GP, on the grounds that he moved over a year earlier. They felt that as the GP had given Mr T details of a new practice during the consultation, Mr T would join straightaway.

The Practice suggested that the swift removal was intended to benefit Mr T by giving him some urgency in enlisting elsewhere. However, it is of no benefit for a patient to be left without a GP. This is particularly true for patients such as Mr T, who have health needs requiring regular monitoring and prescriptions. Six days is not in line with guidance on removing patients. The Practice should have made sure Mr T had already joined a new practice. Mr T contacted NHS England to seek resolution, and only then was he signposted to the Parliamentary and Health Service Ombudsman to take his complaint further.

Care Quality Commission case study

Complaints policies are not followed or well understood by practice staff

A patient complained that the practice receptionist had informed them over the telephone that their magnetic resonance imaging (MRI) brain scan (this provides detailed images of the brain) result was abnormal. The patient immediately attended the practice in an extremely anxious state and subsequently complained about the events that followed.

The Care Quality Commission found that the practice had failed to follow its own complaints procedure:

It had not acknowledged the complaint within the timescales outlined in the policy or the legislation.

There was no record of when, where or who had disclosed the information, or of any investigation.

The complaint record was very brief and there was no evidence that the practice gave an explanation or apology to the complainant.

The Care Quality Commission inspectors checked the staff policy folder and found only the practice manager had signed it to indicate she had read the complaints policy. The reception team were aware of the incident but inspectors found no evidence of them being given guidance or training to prevent a reoccurrence. No learning was identified for the clinical team.

3. Values: be professional

In some instances, we found professionalism was missing from complaint handling, particularly around local resolution meetings. A local resolution meeting is often offered as part of the complaint process. These meetings can have a dual purpose. They give individuals the opportunity to explain to the practice what it is they are unhappy about and what they would like to see happen. The practice has the opportunity to listen, discuss the feedback and consider what it will do. These meetings can take time to prepare, however, they are an opportunity for practices to win back trust and confidence and manage expectations. Our evidence shows that some practices are failing to get the best outcomes from local resolution meetings for three reasons:

There is not a shared view of the aims and outcomes to be addressed before meetings, making it hard to agree on a resolution.

Meetings are not always effectively run – often, they are not chaired by a senior member of staff who is adequately prepared. Sometimes a written agenda including the venue, list of attendees and their job titles, and time frames for the meeting are not agreed with the complainant in advance.

Clarity on next steps is often missing – notes of the meeting with a covering letter confirming actions are often not shared with the complainant afterwards.

Our review has demonstrated that some practices struggle to prevent feedback and concerns from becoming complaints. Practices said that they would welcome complaint handling training that helps them with local resolution, including running meetings effectively.

Although overall practices were good at responding to complaints quickly, some were falling short of expectations because they took too long to acknowledge, investigate and respond to complaints.

The practice has the opportunity to listen, discuss the feedback and consider what it will do.'

In a few instances, practices did not acknowledge or respond to complaints until prompted by either the Parliamentary and Health Service Ombudsman or NHS England. When there are delays, which are sometimes unavoidable, updates are not always provided. Some practices need additional support to understand what is required of them to help them manage complaints effectively.

Our review highlighted that complaints involving more than one organisation can be problematic to resolve and often result in the GP practice responding in isolation to the other issues raised. GP practices told us that they can sometimes struggle to get a response from secondary care, despite a duty to do so:

‘You cannot get a response from a community trust and so eventually you have to respond in isolation. Then you get criticised for an incomplete response. We just don’t have the resources to chase other agencies and we have no way to make them respond.’ A GP.

Not only is this highly unsatisfactory for the person at the centre of the complaint left without a clear understanding of what went wrong and why, it also means other services are missing chances to learn lessons and prevent the same thing happening again. This was found to be an issue in a number of end of life care cases, as illustrated on pages 36 and 37.

Parliamentary and Health Service Ombudsman case study

Multi-agency complaints are handled poorly leaving individuals confused about what happened and why

Mr B complained that his mother’s GP and the nurses at the home where she lived had neglected her and should have done more for her in the days before she died. His main complaint was that his mother had not been given enough fluids or nutrition, and that the GP had become angry when he questioned her about her refusal to give his mother a drip.

The practice and the care home sent Mr B separate responses to his complaint, and the accounts did not match. Mr B remained unhappy and contacted NHS England. NHS England encouraged the practice to respond again.

Parliamentary and Health Service Ombudsman case study

A poorly run local resolution meeting can make matters worse

Mr K went to a walk-in medical centre with stomach and chest pain. A doctor prescribed medication for heartburn and agreed to inform Mr K’s own GP. The centre’s computer system recorded details of the consultation, which were sent to Mr K’s GP that evening, but this information did not reach the GP.
The following month, Mr K saw a GP at his local practice with similar symptoms. Tests were arranged but he suffered a heart attack before he got the results. Mr K complained to the walk-in centre about his care and treatment.

The centre arranged a local resolution meeting, but it was not well organised. Mr K attended with his brother, and an advocate. The centre’s medical director and acting service lead attended, as did its operational director, who had asked to attend at the last minute. It was somewhat heavy handed for two directors to have attended and this was felt to be in response to the advocate’s attendance.

The room layout for the meeting was also less than ideal; taking place in a consulting room, with the operational director sitting on a couch slightly behind Mr K and his brother. The poorly managed meeting prompted Mr K to complain to Parliamentary and Health Service Ombudsman.

Parliamentary and Health Service Ombudsman case study

Practices are responsive and put issues right in a sensitive manner before sending a written response

Mr Q was collecting medication more frequently than was needed and so presented a medical safety issue to his general practice. When Mr Q tried to collect more medication he experienced problems accessing his prescription. This was because it was necessary for Mr Q to have a full review before he received any more prescription medication. Mr Q complained.

Rather than giving Mr Q a written response, the practice manager immediately arranged an appointment for the end of the day to discuss the issue with Mr Q. As Mr Q had anxiety issues relating to clinical environments – he did not like coming into contact with other patients – extra steps were taken to make sure he felt comfortable during the meeting. He was allowed to wait outside the Practice and be telephoned on his mobile phone when the Practice was empty.

To further accommodate Mr Q, a special room was also made available for the appointment, instead of holding the meeting in a clinical environment, which would have added to Mr Q’s anxiety.

As well as resolving all issues raised by Mr Q in person, the practice manager provided him with a written response which clearly explained why Mr Q’s prescriptions had come to their attention. The response also summarised actions taken at the time the complaint was received and suggestions about future care were made.

4. Attitude: apologise where appropriate and be open and honest when things go wrong

The medical defence organisations have stated that saying sorry is not an admission of legal liability and doctors needn’t fear it; it is the right thing to do.26 Yet sometimes sorry seems to be the hardest thing to say; our review found a third of cases did not provide an apology where it would have been appropriate, and when apologies were given, they were not always sincere. ‘Sorry but’ and ‘sorry if’ were often used. In the case outlined below, although the GP apologised and accepted that he might be perceived as rude and dismissive, he defended his poor attitude on the grounds that ‘ultimately we are all humans with human frailties’. An apology like this, which contains a caveat, is less meaningful and valuable.

Simple, clear and meaningful communication is vital to any good complaint handling.'

Despite public guidance from multiple organisations27, GPs told us that fear of litigation and increased indemnity fees prevent practices from apologising. GPs also told us that the advice they get on apologies differs depending on which medicolegal advisor they speak to - in some cases they were told to remove apologies and empathy as they must ‘remain professional’. It was clear that practices felt they were receiving conflicting messages from their defence organisations.

Simple, clear and meaningful communication is vital to any good complaint handling. While practices were reasonably good at using lay language to explain what had happened and why, the factual accuracy of responses required improvement in over a quarter of cases, and explanations regarding decisions about care and treatment were not clear enough in over a third of cases.

Despite the introduction of the Duty of Candour in November 2014, which was formally extended to primary care providers in April 2015, some practices were not always open and honest in instances where it was clear something had gone wrong. For example, mistakes were not appropriately acknowledged in two fifths of cases where things had gone wrong. This was most striking in cases concerning perceived avoidable death or end of life care, as demonstrated in the case on page 40. We heard that GPs can fear liability, litigation and a damaged reputation, which can act as a disincentive to being open and honest, despite a duty to do the right thing. The Care Quality Commission is inspecting and reporting on how practices are meeting their Duty of Candour.

The Ombudsman’s Principles of Good Complaint Handling and the NHS Complaint Regulations (2009) clearly state that complainants should be treated with respect and courtesy and receive an appropriate response.28 We found that often responses that reached the Parliamentary and Health Service Ombudsman’s office lacked empathy and compassion. While in two thirds of cases the complaint response addressed all issues raised, the circumstances of the individual were not always taken into account. Some letters were defensive and dismissive at best and curt at worse. In over a third of the cases we reviewed the response and the outcome of the complaint or concern were not shared in an empathetic manner; for example, failing to acknowledge the loss of a loved one.

Parliamentary and Health Service Ombudsman case study

Responses often lack a human touch and apologies are lacking and insincere

Mr C saw his GP as he was losing weight. Mr C should have been referred under the two-week pathway for suspected gastrointestinal cancer when he first saw his GP. By the time his kidney cancer was diagnosed, several opportunities had been missed to refer him for appropriate investigations. It was impossible to say if earlier diagnosis and treatment would have led to a different outcome for Mr C. Before he died, Mr C complained to the practice about his clinical care and about the attitude of the GP.

The practice took Mr C’s complaint seriously, but because the GP did not accept that any mistakes had been made, no action was taken to put things right for Mr C’s family or make sure that the same thing would not happen to other patients. The written response was lengthy, cumbersome and defensive - there was an apology in response to part of the complaint about the GP’s attitude but it was caveated with ‘although ultimately we are all humans with human frailties’. The practice responded to the complaint within three weeks but Mr C received the response two days before he died.

After her husband’s death, Mrs C complained again to the practice. The second response was very factual and did not contain regret for Mrs C’s loss or acknowledge any mistakes. Given that Mrs C was also a patient at the practice, that she had recently lost her husband and told the practice in her complaint letter that she needed to come to terms with the death, it was surprising that the practice did not offer her any condolences.

NHS England case study

Practices are apologetic, open, and honest when things go wrong

Mr D had been on medication for a long-term condition for a number of years. One of Mr D’s medications was changed incorrectly, which resulted in him requiring hospital treatment. Mr D had concerns regarding the way his long-term condition was managed over a number of years, and complained to his GP practice.

The GP’s response stated that one of the aims of the investigation was to rebuild Mr D’s faith and trust in the practice’s ability to deliver safe care. The response also made it clear that lessons were learned from the complaint.

The GP invited Mr D to correct anything included in the response that he was unhappy with or disputed, and encouraged the process to be two-way in terms of dialogue. The response included a history that went back over many years, which highlighted the specific appointment when the mistake was made.

The GP was reflective and entirely honest in that they could not explain specifically how the mistake had come-to-be, making regular reference to guidance. Through the reflection and openness showed in the response, it was very clear that the GP was very distressed by the mistake and was genuinely sorry. The offer of an out-of-hours meeting was made at the end of the response and it was clear there was no set duration for this as the GP did not want the patient to feel rushed.

NHS England case study

A practice sent a helpful written response to a complaint made verbally

Mr A verbally raised various issues about the treatment he had received from his practice. These concerns ranged from the management of a sensitive medical problem, including a query as to why he was prescribed a particular medication, to being removed from the practice’s list. Mr A had seen numerous doctors during the episode in question.

The response was completed by a GP who was not directly involved with Mr A’s care. The opening section of the response clearly explained that a thorough and independent review of Mr A’s care had been undertaken. The GP thanked Mr A for making the complaint and stated that all feedback, both positive and negative, was welcomed and presented an opportunity to learn.

The response laid out exactly how the investigation had been undertaken, including a review of records as well as taking statements and speaking to staff, and included a summary of events leading to the complaint. The issue of being removed from the practice’s list was handled well and showed evidence of the practice’s policy as well as the written warnings the patient had been given.

The GP turned Mr A’s verbal complaint into a series of questions and identified learning points at the end of each section, as well as making a clear conclusion each time.

5. Learning: listen, respond and share

People often complain about poor public services because they want things to be put right and because they don’t want the same thing happening to someone else. Practices should therefore make sure that service improvements are made as a result of complaints to prevent the same thing happening again. We found that some people do not complain to their GP practice as they don’t think it will make a difference.29

According to Care Quality Commission inspectors, not many practices consider whether there are themes emerging from patient feedback, concerns and complaints. There is a lot of information readily available to practices that can be reviewed to learn lessons and pro-actively improve services. Examples include the Friends and Family Test, NHS Choices website, Parliamentary and Health Service Ombudsman case summaries and investigation reports, Care Quality Commission inspection reports, as well as individuals’ verbal feedback, concerns and complaints. GPs and practice managers told us that time pressure impacted on their ability to do this and that they would welcome support from their Patient Participation Group (PPG).

Our review found that while practices do respond to feedback, concerns and complaints by taking steps to ensure the same thing won’t happen to others, this is not always clearly communicated to people. Notable examples of activity happening without communication to the individual include reviewing working processes with other organisations, changing and updating complaint policies and training staff, for example, in customer service. As a result it is hard for individuals to see what difference their complaint has made and GPs are missing opportunities.

GPs told us they would welcome time to consider how they can learn from complaints so they can improve their practice. They thought that appraisals could usefully focus on what they have learned from complaints more than they do currently. Professional regulators have an important role in helping GPs to learn from complaints.

In even fewer cases, lessons are learned and shared between practices and across localities. Local Medical Committees, CCGs, NHS England, the Care Quality Commission and the Parliamentary and Health Service Ombudsman should work together to lead, inspire, and share what they have learned from complaints to improve the capability of practices. An example of the role CCGs can take in improving primary care complaint handling is shown below.

GPs and their practice managers told us they would welcome the sharing of best practice via templates, real examples and guidance. They also told us that time to share what they have learned from their concerns, as well as individuals’ feedback and complaints at team meetings and across localities would be welcome. CCGs and regional NHS England teams, who hold a variety of feedback that could be used to enhance both reflection and learning, have a role in co-creating this.

They suggested that they would welcome training on how to conduct a Significant Event Analysis (SEA)30, either undertaken by staff identifying an incident or triggered by a complaint. GPs and practice managers told us it would be helpful if training included how to share information with individuals in accordance with the Duty of Candour.

Parliamentary and Health Service Ombudsman case study

Practices don’t ensure that complaints information is used to prevent the same thing happening again, even at an individual level

Mr C was Mrs J’s carer. He complained to the practice about the frequent problems he experienced getting quick and correct repeat prescriptions for Mrs J. He said that Mrs J often had to go without her medication at all on some weekends. The practice tried various ways to sort this out, but the new arrangements gradually failed leaving Mrs J with the same problems. So Mr C complained again.

The practice did not investigate Mr C’s complaint initially – it took three months to respond. When it did respond, its reply was dismissive and made it seem as though it was the patient, rather than its own process that was causing the problems. The response did not explain what had gone wrong, and why items were often missing from Mrs J’s prescriptions, other than suggesting that Mrs J sometimes confused things by contacting the pharmacy herself.

However, as there was only one prescription slip this would have made no difference to what was prescribed. The practice suggested that one solution to Mrs J’s concerns was to find another practice. The alternative practice it suggested was only open three mornings a week and did not provide the specialist services Mrs J needed for her condition.

Healthwatch England case study

In 2013, Healthwatch Bradford gathered views from people across the district about their experiences of GP practices and produced a report called ‘Invisible at the Desk’. In particular, the report raised concerns about the poor experiences of some patients when dealing with receptionists. It said that ‘people often feel that reception staff were acting as “gate-keepers”’ and in some instances were making it difficult for patients to access the appointment they wanted or needed.31

As part of the report, Healthwatch Bradford recommended that reception staff in GP practices should receive ‘customer service’ training. This recommendation was picked up by the Bradford City and Bradford Districts CCG, with the CCGs investing in training for receptionists, in order to see problems from the patients’ perspective.
Training was rolled out throughout the CCGs in 2015, with an ‘enthusiastic response from practice staff’ who wanted to improve the overall quality of patient experience at their practices. Positive feedback was also received from patient participation forums, with one forum member saying that ‘People are coming in with a smile on their face and going out with one’32.

Parliamentary and Health Service Ombudsman case study

GPs are not making it clear when they have made improvements

Mr G complained about the care and treatment the practice gave his wife before she died of cancer. He said the practice had delayed referring her when cancer was suspected, that her symptoms had not been well managed and her care lacked continuity.

The practice responded to Mr G’s complaint quickly, but he felt the response was not objective, had not reassured him the same mistakes would not happen again, and contained inaccuracies. He felt the practice had not been honest with him.

The practice’s response was sensitively written and empathetic. It thanked Mr G for taking the trouble to feed back his concerns, openly acknowledged where he had made a valid point and explained that Mrs G’s case would be discussed with the clinicians as a significant event. The practice responded appropriately and took steps to improve its service – GPs now look back through a patient’s notes to address any chronic issues and identify any ‘red flag’ symptoms.

Unfortunately they did not tell Mr G about the service improvements it had made in response to his complaint. This information may have reassured Mr G that his complaint had been taken seriously as an opportunity to learn.

NHS England case study

A practice that shares what it has learned and openly discusses complaints

After childbirth, Ms N experienced a medical problem and was concerned about future fertility. Ms N saw several clinicians at her GP practice to discuss her concerns. Ms N was unhappy with the advice she was given and felt that her care was not being effectively managed, and she complained.

A partner GP, who was not directly involved with Ms N’s care, undertook a review of her care. As well as reviewing the medical records, the GP partner took a mixture of oral and written statements from the clinicians who saw Ms N. The case was discussed at the practice’s regular team meeting to allow every opportunity to learn from it. The practice response shared all the steps taken with Ms N, including apologies and reassurance about ongoing care.

21 The NHS Friends and Family Test (FFT) was created to help service providers and commissioners understand whether their patients are happy with the service provided, or where improvements are needed.

30 An SEA is a process in which individual episodes (when there has been a significant occurrence either beneficial or damaging) are analysed in a systematic and detailed way to ascertain what can be learned about the overall quality of care, and to indicate any changes that might lead to future improvements.